Pseudohypertension (PHT) could lead to the initiation of unnecessary antihypertensive treatment and potentially adverse consequences. The Finapres is reported to be a reliable alternative to intra-arterial blood pressure (BP) measurements and is unlikely to be distorted by arterial calcification, suggested to be a cause of PHT. Finapres measurements were compared with sphygmomanometric measures of brachial BP. PHT was defined as a systolic pressure (brachial) > or = 190 mm Hg and finger systolic < 160 mm Hg or a diastolic pressure (brachial) > or = 100 mm Hg and finger pressure < 90 mm Hg. One hundred and twenty-five elderly in-patients and out-patients, both hypertensive and normotensive, had a 2.5% prevalence of PHT (1 had diastolic PHT in the left arm, 1 had systolic PHT in the right arm and 1 had systolic PHT in both arms). A group without PHT, but with higher systolic readings with the sphygmomanometer compared with the Finapres (> or = 30 mm Hg) was identified. It was thought that the same factors may affect both pseudohypertensive and non-pseudohypertensive subjects with such large differences. Our data suggest that age plays a role in the presence of higher brachial pressures.